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Tracheotomy for Acute Pulmonary Insufficiency Complicating Chronic Pulmonary Emphysema
LAILEE BAKHTIAR TECIMER, M.D.;
MORTON LEE PEARCE, M.D.
AMA Arch Intern Med. 1960;105(6):891-898.
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The incidence of chronic pulmonary insufficiency, most commonly due to obstructive emphysema, is increasing. The gradual down-hill course of patients with chronic obstructive emphysema and/or pulmonary fibrosis may be punctuated with episodes of acute pulmonary insufficiency. These episodes are usually triggered by respiratory infection. However, they may also result from sedation, anesthetics, and congestive heart failure, strokes, or vomiting with aspiration. Two functional derangements may occur, either alone or in combination. Most frequently there is plugging of bronchi with material which the patient is unable to clear by coughing. This results in an uneven distribution of inspired air with blood flow continuing to unventilated alveoli. Because of the nature of the oxygen hemoglobin dissociation curve this cannot be compensated by increasing ventilation to other alveoli, and anoxemia results. However, there is no such limitation to the removal of carbon dioxide, so there is little increase in the arterial carbon dioxide
. . . [Full Text PDF of this Article]
Author Affiliations
Los Angeles With the Technical Assistance of Joe Yamashita, B.A.
From the Medical Service, Wadsworth General Hospital, Veterans Administration Center and from the Department of Medicine, University of California Medical Center, Los Angeles.
Footnotes
Submitted for publication Aug. 14, 1959.
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